Correlation of Doppler Findings with Perinatal Outcome Among Patients with Pregnancy Induced Hypertension

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Nikita Damle
Manasi Kathaley

Abstract

Background: Hypertensive conditions are the most widely recognized medical complications during pregnancy. Aims and Objectives: In the current study, an attempt was made to understand the significance of Doppler studies in pregnancy induced hypertension and to correlate with the perinatal outcome and to offer better strategies of prevention and early detection and management. Methods: The study comprised of 138 patients admitted in a tertiary care centre at or beyond 28 weeks of gestation with pregnancy induced hypertension (PIH). To determine and monitor a favorable or worsening fetal wellbeing status, follow up Doppler studies were performed though the results of only last Doppler ultrasound within one week of delivery were used for analysis. Patients were followed up till delivery. The maternal and perinatal outcome was studied thereafter. Results: Umbilical Artery (UA) Doppler findings disclosed 26.8% had abnormal umbilical artery S/D ratio, 31.1% had abnormal umbilical artery Recoiling Index (RI) and 2.90% had abnormal umbilical artery Pulsatality Index (PI). Perinatal mortality in the abnormal umbilical artery PI category was found to be the highest (100%) compared to abnormal umbilical S/D artery ratio (66.7%)to be the highest (100%) compared to abnormal umbilical S/D artery ratio (66.7%) and umbilical artery RI ratio (66.7%). In the estimation of adverse perinatal outcome, the predictive accuracy of the umbilical artery S/D ratio in the prediction of adverse perinatal outcome was found to be 73.91%while that of UA RI ratio was 68.12% and the UA PI was 61.59%.Itwas found that in prediction of adverse perinatal outcome, the Umbilical artery PI had higher specificity (97.65%) than the UA S/D ratio (88.24%) and UA RI (80.00%). Fetal middle cerebral artery Doppler studies revealed that 15.2% patients had abnormal MCA S/D ratio, 13.0% had abnormal MCA RI and 15.21% had abnormal MCA PI of which maximum perinatal mortality was seen in abnormal MCA S/D ratio (66.7%) followed by MCA PI (33.3%). Most specific predictor of adverse perinatal outcome was Cerebroplacental ratio (MCA PI/UA PI be (97.65%) The cerebroplacental index has the highest specificity (97.65%)and positive predictive value (93.55%) in predicting adverse perinatal outcome, compared to that of Umbilical artery pusatility index (97.65% and 1.60%) and MCA Pulsatility Index (91.76 and 84.62%) in the present study. Conclusion: The present study noted the prominance of Doppler ultrasound studies in PIH patients, detecting compromised fetuses in utero and taking fitting action in a timely manner.In the present study, the predictive accuracy of the umbilical artery S/D ratio in predicting adverse perinatal outcome was found to be high relative to UA RI and UA PI. In addition, the umbilical artery PI had the highest specificity compared to other Doppler parameters. Absent end diastolic flow and Reversal of end diastolicflow were associated with significant perinatal.

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How to Cite
Damle, N., & Kathaley, M. (2020). Correlation of Doppler Findings with Perinatal Outcome Among Patients with Pregnancy Induced Hypertension. MVP Journal of Medical Sciences, 232–239. https://doi.org/10.18311/mvpjms/2020/v7i2/24674

References

  1. Smitha K, Sowmya K, Malathi T. Study of Doppler waveforms in pregnancy induced hypertension and its correlation with perinatal outcome. Int J ReprodContraceptObstetGynaecol. 2014 Jun; 3(2):428–33. https://doi.org/10.5455/2320-1770.ijrcog20140629.
  2. Gramellini D, Folli MC, Raboni S, Vadora E, Merialdi A. Cerebral- umbilical Doppler ratio as a predictor of adverse perinatal outcome. ObstetGynaecol. 1992; 79:416–20. PMid:1738525. https://doi.org/10.1097/00006250-199203000-00018.
  3. Fong KW, Ohlsson A, Hannah ME, Grisaru S, Kingdom J, Ryan M, Windrim R, Foster G, Amankwah K. Prediction of perinatal outcome in foetuses suspected to have intrauterine growth restriction: Doppler US study of fetal cerebral, renal and umbilical arteries. Radiol.1999; 213:681–9. PMid:10580939. https://doi.org/10.1148/radiology.213.3.r99dc08681.
  4. Lakhkar BN, Rajagopal KV, Gourisankar PT. Doppler prediction of adverse perinatal outcome in PIH and IUGR. Indian J Radiol Imaging. 2006; 16:109–16. https://doi.org/10.4103/0971-3026.29064.
  5. Kofinas AD, Penry M, Nelson LH, Meis PJ, Swain M. Uterine and umbilical artery flow velocity waveform analysis in pregnancies complicated by chronic hypertension or preeclampsia. South Med Journal. 1990; 83:150–5. PMid:2406930. https://doi.org/10.1097/00007611-199002000-00005.
  6. Yoon BH, Lee CM, Kim W. An abnormal umbilical artery wave form: A strong and independent predictor of adverse prenatal outcome in patients with preeclampsia. Am J ObstetGynecol. 1994; 173:713–21. https://doi.org/10.1016/0002-9378(94)90087-6.
  7. Mandruzzato GP, Bogatti P, Fischer L, Gigli C. The clinical significance of absent or reverse end diastolic flow in fetal aorta and umbilical artery. Ultrasound Obstet Gynaecol. 1991; 1(3):192–6. PMid:12797071. https://doi.org/10.1046/j.1469-0705.1991.01030192.x.
  8. Arduini D, Rizzo G, Romanini. Changes of pulsatility media from fetal vessels preceeding the onset of later decelerations in growth retarded fetuses. Obstetrics and Gynaecology. 1992; 79:605–10..
  9. Fairlie FM, More HM, Walker JJ. Determinants of perinatal outcome in pregnancy induced hypertension with absence of umbilical artery end diastolic frequencies. Am J Obstet Gynaecol.1991; 164:1084–9. https://doi.org/10.1016/0002-9378(91)90590-N.
  10. Eronen M, Kari A, Pesonen E, Kaaja R, Wallgren EI, Hallman M. Value of absent or retrograde end diastolic flow in the fetal aorta and umbilical artery as a predictor of perinatal outcome in pregnancy-induced hypertension. ActaPaediatr. 1993;82(11):919–24. PMid:8111171. https://doi.org/10.1111/j.1651-2227.1993.tb12600.x.
  11. Chauhan R, Samiksha T. Role of Doppler study in high risk pregnancy. J Obstet and Gynecol India. 2002; 52(3):51–7.